Health Services – Oregon Medical Health Database

HB 3466 passed during the 2009 session and provides a means by which individuals with mental illness can voluntarily disclose their medical information to a Community Mental Health Program (CMHP) that will then be made accessible to law enforcement agencies during an emergency.

The intent of the legislation was to create a way to help responding agencies assist persons with a qualifying illness or condition in obtaining medical, mental health and social services when responding to a request for an emergency service. If you or a family member is interested in enrolling in this database please complete the Voluntary Consent Form, fill it out, print it and call 541-766-6620 to schedule an appointment.

Volunteer Consent Form

The information in this form will be entered into the Medical Health Database. The information will only be accessed by authorized individuals to provide necessary information to responding law enforcement officers and other responding emergency personnel to assist in an emergency situation.

If you have any questions on the form or process, please contact Dannielle Brown at 541-766-6620.

This document can also be provided upon request in alternative formats for individuals with disabilities. Other formats may include (but are not limited to) large print, Braille, audio recordings, Web-based communications and other electronic formats. E-mail dhs.forms@state.or.us, call 503-378-3486 (voice) or 503-378-3523 (TTY), or fax 503-373-7690 to arrange for the alternative format that will work best for you.